would have you believe. he also takes a critical look at the patient protection and affordable care act commonly known as obamacare and other alternatives like the single payer system. this is about half an hour. ..

despite what has been said about the u.s. health care system, the bottom line really is that it is superb in both access and quality of care. >> what about cost? >> cost is an issue. it is well-documented, and i concur with the documentation. the u.s. is the most expensing system for health care in the world, that is per-capita or any other metric. in this israeli the major problem with the system that should be at where their forms are direct. green down costs. >> dr. alice, some of the reforms have been directed toward bringing down costs. and then not work to your view? >> well, if you are talking about the basic affordability care act or what is now called

obamacare b yum, actually when you look at the numbers the projections under obamacare are actually not that costs will come down. it will put forth as one of the reasons why reform is so essential. yet when you look get even the government alone estimates and all the other agencies come in and of them really predict, projected decrease in health care expenditures compared to a pre obamacare. so this is really one of the ironies of this whole discussion about health care. >> health care costs have never gone down, have they? >> health care costs -- and that thinking make a very good point. they don't generally go down the startling because it is not necessarily desirable to make them go down. for a variety of reasons, the most important of which is technology and medical care have advanced so much over the past

50 to 100 years that we would not want to dial back the clock to when i was born in the 1950's , you know, when the bedside diagnosis was the essence of the diagnosis. we want the technology. the technology, whether diagnostic or new drugs were minimally invasive, say for treatment has actually been the boon for the quality of medical care. so there is a driver of cost that we really don't want to scale back on, and that is that actually it costs money. however, there are ways to increase the kind of -- and i use the word control. as a believer in free market controls, and that is, that people decide what value medical care has for them. unleash competition and get rid of the barriers to competition. give the information access.

by virtue of those kinds of things as in every other service or good in the united states, the price does come down. you may ask what is the fair price. i guess this by my own children. a fair price is the price at which people are willing to pay for something. that is the fair price cannot commend my view, some are richard price fixing or setting by some central authority. >> i you're practicing doctor? >> i have been up until the chilly one year ago when i move from being head of realism wire was for 13 of 14 years a stanford. before that and doing research and teaching. one year ago i move full time over to hoover to work on health care policy. >> when you were practicing physician did you accept medicare and medicaid payments and patients? >> s.

i will give you my own background fitted the -- yes, we did. >> did they peyton -- did the government reimburses the fairest? >> well, that is a difficult question to answer because it implies the subjective term of fair. did they reimburse? yes. the rate was arbitrarily determined. it was always significantly less than private insurance, and i guess one way to assess if it was fair would be to judge how doctors and general react to the reimbursement. and when you look at how they react to the reimbursement rate, the reaction as they're is a decreasing number of doctors are accepting medicare and medicaid patients because, specifically because of the low reimbursement

rates such that they lose money per patient. as rihanna about, you can't make up losing money and. >> you speak about abortion some of the barriers to what you call the fair market rate. what are some of those? >> well, one of the biggest barriers to is really the third-party payer system in general. the barrier would be lack of affirmation. people use some of the good or service, medical care, and it is the only one like this, without knowing what it cost. you don't know what it costs and so you're already use the product. so obviously the possibility the of making a value based decision . secondly, in essentially all of medical care -- and this is a little bit of an overstatement, covered by the insurance itself.

what i mean by that, the way health insurance has evolved from a has changed from the way insurance was intended which is a way to reduce risk of exposure to an unanticipated large expenses. and now health insurance is almost everything aside from a small co-payments or a relatively small deductible for most people. it is paid by the insurer, so you don't really care what it costs because someone else is paying. you're paying in the end, but is a very complicated and indirect route. the biggest barrier i think is that there is no incentive to even look at the cost. and when something is freebie your tendency is, let's consumed as much as we want because i'm not paying for it. that is the number one barrier. the second barrier island said, the government created health

insurance coverages themselves. that is, as we know, the state's control of insurance. kind of to subsegments to that question. one is, you're not allowed to buy insurance from a statement outside the state in which you live. this, of course, nonsense poem and does not really exist in other goods and services, and it is archaic and and paternalistic as a way to view things. we are afraid that you will not know what you're doing. of course if you live in new jersey as bono why those people cannot shop and pennsylvania. that is one problem. a monopoly. as a barrier to competition for insurance. the second issue with the states and canal over 2000 mandates. that is requirements for all health insurance policies to cover things that many people, i

think, rather obviously would never want to pay for, and i will give some examples. massage therapy, acupuncture, chiropractors, in vitro fertilization. when i give a lecture i would look in the audience. most of the people here and i'm not trying to use in vitro fertilization. insurance is required to approve that coverage, and there are a lot of mandates that are estimated to ramp up the cost of health insurance by as much as 50% to. so there's a barrier to competition because there is have the opportunity to get people to buy the insurance covers a actually want to which would be cheaper number. so there are a whole host of things that government has an opportunity. a big one that failed to mention is a lack of information. is not just about price. it's about quality. there is no transparency. you go and you get an mri scan.

in don't know not only what it costs, but you really don't know who the doctors are. you know of the place has board certified doctors, people who have training. you don't know when you get elective surgery if you're going to a place where they do a lot of these procedures. so there is a huge amount of affirmation if that is necessary if people are expected to make value based decisions. of course the question then comes, are people able to make these decisions. medical care is so complicated. and my answer to that is, there is no question that you can make decisions like that as patients in concert with doctors because we do this all the time with things we don't understand. for instance, i'm not sure many people could explain how a computer really works in very great detail, yet we're pretty good shoppers for computers. so i think in concert with

doctors and particularly now in the age of reformation drug people actually very, very good at talking to the patient's side about what the medical care and sales, given the opportunity and incentive. and when you give them the incentive there are a variety of ways to do that. the cost as comedown. >> one of the major in factors in the affordable care acted is the marketplace, the so-called market place that can be created for people can shop for insurance and perhaps there will be more competition. is that a step in the right direction? >> you're talking about the health insurance exchanges which are now turned health-insurance marketplace is. and in general i would say that the ibm, the concept of health insurance exchanges very good. but the problem is that the implementation, as every good

idea, the execution of ideas -- the idea is the key. look at the exchanges that i have set up under the affordability care act. some major problems that are so bad that they cannot really possibly function well, and i will go through the three basic problems. the first problem is that there is this so-called minimum essential benefits coverage. and this sounds like -- okay. minimum essential benefit sounds attractive. the problem is that when you look at those is such an enormous what is called a comprehensive list of medical benefits that the price of the policy to cover all those things is unnecessarily high and it eliminates the possibility for people to buy insurance policies tailored to what they actually want. the prices are jacked up because all of this coverage is required

of all the policies that are eligible to be full. secondly mean there's something called the mineral mosser sharon which is an edict by the affordability character that quantifies how much an insurance company can actually make a profit last and declared as administrative cost. when you look at the minimum loss ratio to the have necessarily limited cheaper coverage under the so-called high deductible health care plan. high deductible health care plans are not only cheaper in but there are more desired, the most popular choice over the past five years, the increase of employer sponsored health insurance by employees. why? because they're cheaper. you get to take money can be put into a savings account and you get the money afterwards. and it really, wellness programs

and other screening. people actually wanted to encourage healthy living. these things are excluded by the minimum loss ratio or at least flooded by though minimal loss for sure. the third and perhaps most important thing that we are really doing is the idea that health insurers announced, the insurance policies must use guaranteed issue. no matter what preexisting condition your half you must be able to get the insurance and it eliminates the way in. you would have to -- you would be able to buy insurance if you just waited until the day you got sick. makes people say, okay. why why bother to have insurance until the data sick? and that would be a rational way the third problem is that there

is no real difference in the premium for your risk factors except for cigarette smoking. you are not allowed to change the prices on the basis of much of anything, so everyone has the same prices, guaranteed issue no matter what risky behavior said your engaging in command there is no real the late in buying the insurance. so, again, these things are going to make insurance companies kind of a no-win situation. it is not really possible to exist under that kind of scenario. >> the arguments that you set forth in excellent health and the facts, is it too late to implement them since we're already on the road? >> well, this is something that is a very good question. i don't have a real answer. although we can say i think it is clear that unless something

dramatic happens in the election , obamacare, the hca is really a law. i think that realistically i do not see it being completely abolished. maybe other people disagree with me. so when that -- given that scenario there are things that can be modified. for instance the mother are bills passed all the time, although they are not really by one house. they're not being implemented yet why not sure that there will be coming to get rid of some of the negative edith's in. for instance, the tax on medical device companies that will necessarily cause job loss, but also a lack of access to new technologies for patience. and these are things that a lot of congress and senate members can agree and because it affects their own constituency. and then we can go through.

for instance, to the ideas about how to change his requirements on health insurance policies for these changes that i mentioned. citing not think that it is too late to modify and even dramatically changed parts of the icam. i have a feeling that it is unrealistic to say that the entire law will be repealed. >> you talk about americans having good access to health care. is some of that access, however, three emergency rooms? >> well, if you look at the data , i think that the answer is probably no. there are two parts of your question. one is bad, to clarify, there is a huge difference and access to health care, no matter how you define it, or there is access to specialists, general care to medication, procedures, or

americans, far better than any of the other time countries held up as models for health care reform in the u.s. and we can go through much of the data, but the data is in the books. secondly the question that u.s., the people get the care through emergency rooms to many answer is sometimes a doom. no one is saying that it is just as good. they have no insurance as a list have insurance. generally a lot of people go through emergency rooms to get that care. however, a lot of the care given to people, even the uninsured, not through the emergency room manassites some statistics in the book. it is a misconception that people without insurance don't get access to care. so some of these issues, people that it accessorizes rooms that really don't need them. on the other hand, i think it has really been remarkably --

markedly distorted. >> to the embarrassment of the government's decentralize health care restricting access government officials themselves will circumvent restrictions when they're own personal care is a stake. the national health service in great britain spent more than one-half million pounds to pay for thousands of its of staff members of the leapfrog the waiting lists. the prime minister and of italy was to have his or cardiac pacemaker surgery at the renowned cleveland clinic in '06. and when president obama was asked pointed glean to promise that he would not seek out a plan help for his wife $4 if they became sick, the president refused saying if it is my family member, wife, if it is my children, if it is my grandmother i always wanted to get the very best care of. >> that's right. and i think people ought to know

that even the most vocal proponents in the united states of the single payer health care for themselves and faced with the need for health care god do everything they can to manipulate the system and access their own right which is choice. they want choice to pursue health care options for themselves. adeline of this? i have been one of the doctors sought out frequently by several people. a proponent of single payer health care. i feel good about reviewing this because it was in the public record. i read the mri scans of him when he had his brain tumor. it is not that he was my patient. he sought out and all of this power doctors in the country.

and i think you make a broader point here that i would like to emphasize which is that when you look at these other countries the single payer system, they not only individually seek about ways around the barriers, they have even put into law that these countries will pay for medical care either in private care centers are outside their own country. while we in the u.s. somehow have been moving toward a more nationalize system, the countries that have the experience is the movement toward privatization.

>> people want to send u.s. say, well, he is a doctor comenius to make less dollars. >> that think we have to look at -- this is the tricky part of health care. this is the kind of ethical and moral dilemma that gets into the discussion which is the people that say to my health care is different from everything else. healthcare is a right to command in the ideal world, everybody would have everything for free. they could not pay somebody else just may be the ideal world. you know, we don't have that attitude about clothing. we don't have that attitude about having a home.

everyone should have clothing and the government should pay for it. everyone should have food. it does not work that way. the reality of life is about things cost money. somebody has to pay for it. did doctors make too much money? i don't think there is anyone that should say someone makes too much money. the u.s. to meet, a broad philosophical question that everyone to go down. a point of the united states is this is a land of opportunity. as long as there is equal opportunity nobody guarantees equal outcomes. and so i personally do not buy into the argument that you should not make that kind of money. he would pay for, and if you want to have a medical system where everyone is working as if it is a public sector job with

limits on what they earn and dictated by government you better be prepared to have medical care function like the u.s. post office. they're is a reasoned why doctors flop from all of the world to the top by the doctors in the united states. i have been engaged with many, many years on continuing medical education courses both here and abroad. and by far the leaders in innovation, the leading educators of the world's doctors are american doctors. we don't go to other countries to learn new medical care. they'll come here. and this is generally true, overwhelmingly so. but if you want to make doctors forced into this widget of public employee, you're going to get what you pay for. we are already seeing a little bit of that. you look at the surveys of doctors and their future plans,

many doctors are getting out of the field. you will see, if you want the so-called best and brightest which are not -- on that area enough to say that there in madison, but there is very, very good people in the medical field in the united states. if you want to clamp down on things and start telling them what they're going to turn and that this administrative costs and all these other things delaying the return on investment, if you will because you now start making money into your in your mid-30s, you're going to get what to pay for. >> what do you say to people lose a doctor's order to many tests, gaming the system, making extra money. >> i think that there is certainly some medical waste, no question about that. i think that there has been of

little bit of distortion in terms of doctors gaming the system without saying it never happens. people say that these radiologists, people order in our eyes and ct scans. that is illegal. it's actually not true. no one can order a test like a diagnostic test. and in other countries, but not in the united states. is true, redundancy and waste in the u.s. there are certainly attempts going on now particularly with electronic medical records and other things, an attempt to streamline the system, get rid of that waste and redundancy and cost in the system, but would say that that is not the biggest problem at all in terms of the way the national health

expenditures are going. >> the world health organization often rates the u.s. health care system lower them what you're saying? >> you have to look at the actual study, which i did in his book. rather than just take the bottom line. you know, a bit of writing. a eroded after a dinner party discussing a michael more movie. the random kind of numbers. the u.s. health care system, the who report of 191 nations. right 37 the world. amid countries, places that are really not paradigms' of health care by any common assessment. let me look at these studies. specific details. the public health.

we know that the studies were seriously flawed, almost two-thirds of the ranking comprises scores based upon the quality, by the inequality. rewarding countries that have medical care where everyone got a c. that was deemed better than a country where some people in that country and then some people that is seen. it makes no sense. better to be equaled but worse in the eyes of the who report, and there are many other things that are set up and that may report of the year 2000 such as when there was no data available . the literally filled again. it was so bad that in 2009 the head of health care which was the organization basically economically investor interest, the who report is one of those things that we wish would just

go away. it was so poorly done, what it got a lot of traction and still does. and you listen to our own government leaders to talk about how the u.s. as inferior health care. they base it on these rankings. in thin mortality, they are so flawed. actually defined in ways that the u.s. would necessarily have a bad ranking. when you really -- i think you realize the truth. >> what do you think of the male model? >> i think it works well for what it is. it is a unique place amongst all of the medical centers in the year added states and health care delivery in general. and that is that if they -- the referral center, it has a reputation.

the perceived quality. they do things they're own way. it works well for what is. they have all kinds of things going on. so a lot of economic challenges. >> we have been talking with scott atlas. in excellent health. inky for being an book tv. >> pleasure to be here. >> now from the libertarian cato institute in washington d.c. global crossings. the book oo